Lipids in Health and Disease ( IF 3.9 ) Pub Date : 2021-07-15 , DOI: 10.1186/s12944-021-01495-9 Gregory C Henderson 1
When considering lifestyle factors such as consumption of fruits and vegetables, and leading a physically active lifestyle, the benefits are often ascribed to the long-term, chronic effects of each lifestyle factor. An example of this long-term mindset would be views of antioxidant biology; long-term intakes of anti-oxidants could potentially prevent the accumulation of oxidative damage to DNA and other cellular constituents that accumulate over months and years. However, it is important to note that lifestyle factors (e.g., nutrition) typically have both acute and chronic effects. The acute effects of nutrient intake can be manifested as a modification of postprandial metabolism following the individual meal in which that specific food was consumed. With a substantial portion of each day spent in the postprandial state, any effects of diet selection on postprandial metabolism could exert major health impacts. It is a well-accepted goal to maintain blood glucose and blood lipids within desirable ranges over the course of each day, and these factors respond to the components of each individual meal. Following each mixed meal, circulating levels of glucose and triacylglycerol (TAG) rise and then fall. Each rise contributes to the subject’s lifetime total exposure of blood vessels and tissues to these metabolites. The acute effects of each meal accumulate over the years. While the majority of nutrition research in the past has been focused on chronic intake of foods, the acute effects of consuming specific foods within a meal are also important for understanding health properties of nutrition.
Including specific foods into a meal may modify the stresses imposed upon metabolism following that meal. For example, as discussed above, glucose and lipoprotein responses to a meal could be modified by specific foods or food groups. General effects of dietary fiber and macronutrient composition in test meals upon blood glucose and TAG have been elucidated previously [4, 10]; however, significant gaps in knowledge remain. To translate our understanding to real-world application, a greater level of information is needed in relation to the intake of complex dietary components that simultaneously deliver digestible macronutrients, fiber, micronutrients, and trace levels of other important biologically active compounds. Specific foods, such as leafy green vegetables, might have impacts that are beyond those which we would predict based upon our current understanding. To develop knowledge about the benefits of specific foods that are likely to be healthful, acute studies of specific foods are needed, such as specific leafy greens and other vegetables.
It is of public health interest that blood glucose and TAG rise in individuals following consumption of each mixed meal, because postprandial responses of blood glucose [5] and TAG [1] are risk factors for developing metabolic and cardiovascular diseases. Thus, developing new approaches to blunt the responses is desirable. In the current issue of Lipids in Health and Disease, Shokraei and colleagues [12] performed a randomized, controlled, cross-over trial to investigate acute responses to three different meals. In this study of healthy young men, the authors administered test meals to study the acute responses of blood glucose and lipoproteins. The work of Shokraei et al. is important for advancing the field forward, and it will be advantageous to the scientific community if a greater number of such translational studies of acute nutrition are conducted in the future by investigators around the world. In the study by Shokraei et al. [12], each meal contained approximately 800 kcal of energy with a macronutrient composition that somewhat reasonably matches that of a typical daily intake, with the majority of energy from carbohydrate (CHO), a substantial proportion of energy from fat, and the remaining balance from protein (~ 50% CHO, ~ 40% fat, ~ 10% protein). On each of 3 occasions, participants consumed the meal with addition of romaine lettuce, watercress, or inclusion of cellulose (fiber) to the control meal in place of the leafy green vegetables. Blood was drawn periodically over 4 h following each meal for tracking of blood glucose and lipoproteins. As compared with the fiber-containing control meal, addition of these leafy greens did not significantly alter the responses of circulating TAG or other components of the lipoprotein profile. However, the postprandial blood glucose response was blunted when lettuce was consumed with the meal, in comparison to meals containing watercress or fiber supplement. While blood glucose rose following the meals containing cellulose or watercress, when the meal contained lettuce blood glucose actually trended downward in the postprandial period. This divergent response in the lettuce trial led to a significant main effect of the meal in the statistical analysis, indicating that the post-meal blood glucose profile was lower in the lettuce-containing meal. It is noteworthy that the response to romaine lettuce could not be recapitulated by addition of a different leafy green (watercress) or by fiber intake alone. Thus, the benefits of romaine lettuce intake upon glycemic control may be unique to this specific food, and it is unknown how generalizable this discovery is to other types of vegetables and other types of lettuce. The findings are encouraging and point to a need for additional research.
The work by Shokraei and colleagues is an excellent example of translational science. In translational research, it is ideal to develop a study design that incorporates aspects of the real-world experience of humans, in order to maximize clinical relevance. The authors have achieved this goal by testing specific leafy vegetables within a well-controlled test meal. They have tested real foods that one may select for inclusion in meals in daily life, yet they conducted the research in a laboratory setting with application of useful biochemical measurements. Thus, the work was translational as it was within the spectrum from basic science to clinical research (or from “bench to bedside”), incorporating aspects of basic science laboratory control as well as aspects of real-world meal consumption. Often in translational studies of postprandial metabolism, physical activity on the day of experimentation is rigidly controlled. For example, to exclude potential impacts of physical activity when studying nutrition, often subjects would be asked to remain nearly motionless for the entire day. When physical activity is limited in this situation, the trials would be scheduled on days when students need not attend class or when employed individuals need not report to their jobs. However, Shokraei and colleagues took a different approach and chose to allow greater levels of physical activity in the participants. The research subject population included students, and subjects were permitted to leave the laboratory between blood draws to attend classes [12]. The authors report that approximately 40% of the subjects did walk to classes between blood draws. Allowing participants to carry out these activities reflects the translational nature of the study, as it makes the study design similar to a normal day in the life of the participants. However, while this lack of physical activity control perhaps makes the results applicable to the real world, it is also a potential weakness of the study. It is known from previous publications that a recent bout of exercise can reduce blood glucose and plasma TAG for hours [3, 7, 8]. While the subjects did not exercise at any intense level, one could postulate that bouts of walking might have some similar effect, yet to a lesser extent. Indeed, it has been reported that even brief bouts of walking spaced throughout the day, to break up sedentary sitting behavior, can reduce blood glucose concentrations [2, 6, 9, 11]. Thus, permitting subjects to leave the laboratory on foot between blood draws in the study by Shokraei et al. could have led to reduced blood glucose levels. Nonetheless, the authors report that physical activity patterns were similar between the lettuce, watercress, and fiber control trials; therefore, it is expected that the findings for effects of lettuce upon blood glucose are valid, yet it should be noted that the benefits of lettuce were observed on the background of the potential benefits of physical activity in nearly half of the participants. This mixture of possible physical activity effects and food effects upon metabolism is of course what occurs in real daily life, and it might be of interest in the future to further explore any interactions between physical activity and vegetable intake upon postprandial blood glucose levels. Clearly, the study by Shokraei and colleagues paves the way for future work on other dietary components, clinical populations, and potential interactions between diet and physical activity. Their study represents a valuable step forward in our understanding of dietary patterns and health. Additionally, as is often the case with impactful research, the study leads to many questions that will require future studies to fill the remaining knowledge gaps.
The study by Shokraei and colleagues exemplifies the notion that healthy foods need not be consumed regularly, for many months, in order to achieve initial health benefits. While long-term intake of leafy greens is certainly advisable, inclusion of certain leafy vegetables (such as romaine lettuce) in even a single meal can improve the postprandial metabolic milieu on that occasion through acute effects upon metabolism. The cumulative effect of the 24-h integrated blood glucose and lipid levels, over many months and years, ultimately exerts a meaningful impact on one’s disease risk; a promising approach for reducing this risk is to focus upon improving the postprandial response to each individual meal by including foods which exert acute effects upon postprandial metabolism. Discovering ways to alter the response of glycemia to each meal would be of high clinical value, such that over the years an individual experiences a lower total exposure of blood vessels to glucose. Thus, the authors are commended for performing a valuable study of the acute responses to nutrition. This study [12] is very encouraging and is supportive of the concept that foods can exert their benefits through acute effects upon metabolism immediately following consumption. Studying romaine lettuce has led to important new knowledge, and the findings may inspire future work on other potentially healthful components of the diet. Considering the vast number of leafy greens and other vegetables available to consumers, it is clear that the present results about lettuce may only be the tip of the iceberg.
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Henderson, G.C. Lettuce romaine calm and manage our glycemia: adding leafy greens to a meal may improve postprandial metabolism. Lipids Health Dis 20, 67 (2021). https://doi.org/10.1186/s12944-021-01495-9
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DOI: https://doi.org/10.1186/s12944-021-01495-9
中文翻译：
生菜可以镇静并控制血糖：在膳食中添加绿叶蔬菜可以改善餐后新陈代谢
当考虑生活方式因素（例如水果和蔬菜的消费以及积极锻炼的生活方式）时，这些好处通常归因于每种生活方式因素的长期、慢性影响。这种长期心态的一个例子是抗氧化生物学的观点。长期摄入抗氧化剂可能会防止DNA和其他细胞成分在数月和数年中积累的氧化损伤的累积。然而，值得注意的是，生活方式因素（例如营养）通常会产生急性和慢性影响。营养摄入的急性影响可以表现为食用特定食物的单餐后餐后代谢的改变。由于每天有很大一部分时间是在餐后状态度过的，饮食选择对餐后代谢的任何影响都可能对健康产生重大影响。将每天的血糖和血脂维持在理想的范围内是一个广为接受的目标，并且这些因素对每餐的成分做出反应。每顿混合餐后，葡萄糖和三酰甘油（TAG）的循环水平先上升后下降。每次上升都会导致受试者一生中血管和组织对这些代谢物的总暴露量。每顿饭的急性影响会随着时间的推移而累积。虽然过去大多数营养研究都集中在食物的长期摄入上，但膳食中食用特定食物的急性影响对于了解营养的健康特性也很重要。
在膳食中加入特定的食物可能会改变膳食后新陈代谢所承受的压力。例如，如上所述，特定食物或食物组可以改变对膳食的葡萄糖和脂蛋白反应。先前已阐明测试餐中膳食纤维和常量营养素成分对血糖和 TAG 的一般影响 [4, 10]；然而，知识方面仍然存在重大差距。为了将我们的理解转化为现实世界的应用，需要更多关于复杂膳食成分摄入的信息，这些成分同时提供可消化的常量营养素、纤维、微量营养素和痕量水平的其他重要生物活性化合物。特定食物，例如绿叶蔬菜，可能产生的影响超出了我们根据目前的理解所预测的范围。为了了解可能有益健康的特定食物的益处，需要对特定食物进行深入研究，例如特定的绿叶蔬菜和其他蔬菜。
每餐混合餐后，个体血糖和 TAG 都会升高，这符合公共卫生利益，因为餐后血糖 [5] 和 TAG [1] 的反应是发生代谢和心血管疾病的危险因素。因此，开发新的方法来减弱反应是可取的。在最新一期的《健康与疾病中的脂质》中，Shokraei 及其同事 [12] 进行了一项随机、对照、交叉试验，以调查对三种不同膳食的急性反应。在这项针对健康年轻男性的研究中，作者进行了测试膳食以研究血糖和脂蛋白的急性反应。 Shokraei 等人的工作。对于推动该领域的发展非常重要，如果世界各地的研究人员未来开展更多此类急性营养转化研究，将对科学界有利。 Shokraei 等人的研究中。 [12]，每顿饭含有大约 800 kcal 的能量，其宏量营养素成分在一定程度上与典型的每日摄入量相当，其中大部分能量来自碳水化合物 (CHO)，相当一部分能量来自脂肪，其余平衡来自蛋白质（~ 50% CHO、~ 40% 脂肪、~ 10% 蛋白质）。参与者在 3 次食用的餐食中添加了生菜、豆瓣菜或在对照餐中添加纤维素（纤维）来代替绿叶蔬菜。每餐后 4 小时内定期抽血以追踪血糖和脂蛋白。与含纤维对照餐相比，添加这些绿叶蔬菜并没有显着改变循环 TAG 或脂蛋白谱其他成分的反应。 然而，与含有西洋菜或纤维补充剂的膳食相比，当膳食中食用生菜时，餐后血糖反应会减弱。虽然进食含有纤维素或豆瓣菜的膳食后血糖会上升，但当膳食含有生菜时，血糖实际上在餐后呈下降趋势。生菜试验中的这种不同反应导致了统计分析中膳食的显着主效应，表明含生菜膳食的餐后血糖曲线较低。值得注意的是，对生菜的反应不能通过添加不同的绿叶蔬菜（西洋菜）或单独摄入纤维来概括。因此，摄入长叶生菜对血糖控制的益处可能是这种特定食物所独有的，目前尚不清楚这一发现对其他类型的蔬菜和其他类型的生菜是否具有普遍性。研究结果令人鼓舞，并表明需要进行更多研究。
Shokraei 及其同事的工作是转化科学的一个很好的例子。在转化研究中，理想的做法是开发一种结合人类现实世界经验的研究设计，以最大限度地提高临床相关性。作者通过在严格控制的测试餐中测试特定的叶类蔬菜来实现这一目标。他们测试了人们在日常生活中可能选择包含在膳食中的真实食物，但他们在实验室环境中利用有用的生化测量进行了研究。因此，这项工作是转化性的，因为它涉及从基础科学到临床研究（或从“实验室到床边”）的范围，结合了基础科学实验室控制的各个方面以及现实世界膳食消费的各个方面。在餐后代谢的转化研究中，实验当天的体力活动通常受到严格控制。例如，在研究营养时，为了排除体力活动的潜在影响，通常会要求受试者一整天保持几乎一动不动。如果在这种情况下体力活动受到限制，试验将安排在学生不需要上课或就业人员不需要上班的日子。然而，Shokraei 和同事采取了不同的方法，选择允许参与者进行更高水平的体力活动。研究对象群体包括学生，并且对象被允许在抽血之间离开实验室去上课[12]。作者报告说，大约 40% 的受试者在抽血期间步行去上课。 允许参与者开展这些活动反映了研究的转化性质，因为它使研究设计类似于参与者生活中的正常一天。然而，虽然缺乏身体活动控制可能使结果适用于现实世界，但这也是该研究的一个潜在弱点。从之前的出版物中得知，最近的一次运动可以降低血糖和血浆 TAG 数小时[3,7,8]。虽然受试者没有进行任何强度的锻炼，但我们可以推测，步行可能会产生一些类似的效果，但程度较小。事实上，据报道，即使是全天短暂的步行，以打破久坐的行为，也可以降低血糖浓度 [2,6,9,11]。因此，在 Shokraei 等人的研究中，允许受试者在抽血之间步行离开实验室。可能会导致血糖水平降低。尽管如此，作者报告说，生菜、豆瓣菜和纤维对照试验之间的体力活动模式相似。因此，预计生菜对血糖影响的研究结果是有效的，但应该指出的是，生菜的益处是在近一半的参与者体力活动的潜在益处的背景下观察到的。这种可能的身体活动影响和食物对新陈代谢的影响的混合当然是在现实日常生活中发生的情况，未来进一步探索身体活动和蔬菜摄入量对餐后血糖水平之间的相互作用可能会很有意义。 显然，Shokraei 及其同事的研究为未来研究其他饮食成分、临床人群以及饮食与身体活动之间的潜在相互作用铺平了道路。他们的研究代表着我们在理解饮食模式和健康方面向前迈出了宝贵的一步。此外，正如有影响力的研究经常出现的情况一样，该研究会引发许多问题，需要未来的研究来填补剩余的知识空白。
Shokraei 及其同事的研究例证了这样一种观点：健康食品不需要连续几个月定期食用，才能获得最初的健康益处。虽然长期摄入绿叶蔬菜当然是可取的，但即使在一顿饭中加入某些绿叶蔬菜（例如生菜）也可以通过对新陈代谢的急性影响来改善餐后代谢环境。 24 小时综合血糖和血脂水平经过数月和数年的累积效应，最终对一个人的疾病风险产生有意义的影响；降低这种风险的一个有希望的方法是通过添加对餐后代谢产生急性影响的食物来改善每餐的餐后反应。发现改变血糖对每餐的反应的方法将具有很高的临床价值，这样多年来，个体的血管对葡萄糖的总暴露量就会降低。因此，作者因对营养的急性反应进行了有价值的研究而受到赞扬。这项研究 [12] 非常令人鼓舞，并且支持这样的概念：食物可以通过在食用后立即对新陈代谢产生急性影响来发挥其益处。研究长叶生菜带来了重要的新知识，这些发现可能会启发未来对饮食中其他潜在健康成分的研究。考虑到消费者可以获得大量的绿叶蔬菜和其他蔬菜，很明显，目前有关生菜的结果可能只是冰山一角。
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Henderson，GC 生菜可以镇静并控制血糖：在膳食中添加绿叶蔬菜可以改善餐后新陈代谢。脂质健康 Dis 20, 67 (2021)。 https://doi.org/10.1186/s12944-021-01495-9
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